Euthanasia, Ethics, and Public Policy: An Argument against Legalisation

By John Keown | Go to book overview

20
Beyond Bland: the BMA guidance on
with holding/with drawing medical treatment

In June 1999 the BMA published important guidance on the withholding/withdrawal of 'medical treatment', so defined as to include food and water delivered by tube.1 The guidance endorses the withholding/withdrawal of tube-delivered food and water not only from patients in pvs but also from other non-terminally ill patients such as those with severe dementia or serious stroke.2 The underlying justification for nontreatment appears (as in Bland) to be that such lives are not worth living and that it is right to end them by purposeful omission.

Published by the Medical Ethics Committee of the BMA, the guidance was prepared by a working group comprising nine of the Committee's twenty-five members and was written by three members of the BMA administrative staff.3 The Foreword states that a consultation exercise which the BMA had carried out in 1998,4 and which had generated over 2,000 responses, has revealed a need for guidance and that one of the most difficult issues was withholding/withdrawing tube-delivered food and water. Confusion had arisen from the fact that judicial guidance on this question related only to patients in pvs, and the BMA therefore wanted to provide guidance outlining the criteria to be applied in other conditions, such as advanced dementia or severe stroke.5 The guidance sought to 'document

____________________
1
Withholding and Withdrawing Life-Prolonging Medical Treatment. Guidance for Decision Making (1999) (hereafter 'Guidance').
2
Indeed, the main focus of the guidance is not on the terminally ill, but on those who could live for months or even years (Guidance, 4 para. 2.1).
3
The Working Groupcomprised:Dr Michael Wilks(Chairmanofthe Medical Ethics Committee) Dr Andrew Carney, Professor Len Doyal, Professor Raanan Gillon, Professor Sheila Mc Lean, Mr Derek Morgan, Dr Jane Richards, Dr Jeremy Wight and Ms Rosie Wilkinson. It was written by Veronica English, Gillian Romano-Critchley and Ann Sommerville (Guidance, xi–xiii).
4
Guidance, xv(refering to Withholding and Withdrawing Treatment: A Consultation Paper from the BMA's Medical Ethics Committee (1998)).
5
Guidance, ix.

-239-

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Euthanasia, Ethics, and Public Policy: An Argument against Legalisation
Table of contents

Table of contents

  • Title Page *
  • Contents vii
  • Preface xi
  • Foreword xiii
  • Acknowledgments xv
  • Table of Cases xvi
  • Abbreviations xviii
  • Introduction 1
  • Part I - Definitions 7
  • 1 - 'Voluntary Euthanasia' 9
  • 2 - Intended V. Foreseen Life-Shortening 18
  • 3 - 'Physician-Assisted Suicide' 31
  • Part II - The Ethical Debate: Human Life, Autonomy, Legal Hypocrisy, and the Slippery Slope 37
  • 4 - The Value of Human Life 39
  • 5 - The Value of Autonomy 52
  • 6 - Legal Hypocrisy? 58
  • 7 - The Slippery Slope Arguments 70
  • Part III - The Dutch Experience: Controlling Vae? Condoning Nvae? 81
  • 8 - The Guidelines 83
  • 9 - The First Survey: the Incidence of 'Euthanasia' 91
  • 10 - Breach of the Guidelines 103
  • 11 - The Slide Towards Nvae 115
  • 12 - The Second Survey 125
  • 13 - The Dutch in Denial? 136
  • Part IV - Australia and the United States 151
  • 14 - The Northern Territory: Rotti 153
  • 15 - Oregon: the Death with Dignity Act 167
  • Part V - Expert Opinion 181
  • 16 - Expert Committees 183
  • 17 - Supreme Courts 191
  • 18 - Medical Associations 208
  • Part VI - Passive Euthanasia: Withholding/withdrawing Treatment and Tube-Feeding with Intent to Kill 215
  • 19 - The Tony Bland Case 217
  • 20 - Beyond Bland: the Bma Guidance on Withholding/withdrawing Medical Treatment 239
  • 21 - The Winterton Bill 260
  • Conclusions 273
  • Afterword: the Diane Pretty Case 282
  • Bibliography 292
  • Index 303
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